Trends in concussions at Ontario schools prior to and subsequent to the introduction of a concussion policy - an analysis of the Canadian hospitals injury reporting and prevention program from 2009 to 2016.

BACKGROUND: Concussion is a preventable injury that can have long-term health consequences for children and youth. In Ontario, the Policy/Program Memorandum # 158 (PPM) was introduced by the Ministry of Education of Ontario in March 2014. The PPM's main purpose is to require each school board in the province to create and implement a concussion policy. The purpose of this paper is to examine trends in school-based concussions prior to and subsequent to the introduction of the PPM.

METHODS: This report examined emergency department (ED) visits in 5 Ontario hospitals that are part of the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), and compared trends over time in diagnosed concussions, and suspected concussions identified as "other head injury" in children and youth aged 4-18.

RESULTS: From 2009 to 2016 study years, there were 21,094 suspected concussions, including 8934 diagnosed concussions in youth aged 4-18. The average number of diagnosed concussions in the 5 years before the PPM was 89 concussions/month, compared to approximately 117 concussions per month after; a 30% increase in the monthly rate of concussions presenting to the ED. The total number of concussion or head injury-related ED visits remained relatively unchanged but the proportion of diagnosed concussions rose from 31% in 2009 to 53% in 2016. The proportion of diagnosed concussions in females also increased from 38% in 2013 to 46% in 2016. The percent of all diagnosed concussions occurring at schools increased throughout the study reaching almost 50% in 2016 with most injuries taking place at the playground (24%), gymnasium (22%) or sports field (20%).

CONCLUSIONS: The introduction of the PPM may have contributed to a general increase in concussion awareness and an improvement in concussion identification at the school level in children and youth aged 4-18.